# Human Papillomavirus Self-Sampling Attitudes Amongst Women Living with HIV Prior to a Self-Sampling Intervention

## TL;DR

Women with HIV in Canada are generally accepting of self-collecting HPV tests for cervical cancer screening, but some worry about the consequences of a positive result.

## Contribution

This study explores the acceptability of HPV self-sampling among women with HIV and identifies concerns related to positive test outcomes.

## Key findings

- Most women with HIV felt confident in their ability to self-collect HPV samples correctly.
- Many participants preferred self-sampling over provider-collected sampling for cervical cancer screening.
- A significant proportion of participants were concerned about the implications of a positive HPV test result.

## Abstract

Human Papillomavirus (HPV) causes almost all cervical cancers. Women with HIV experience higher rates of HPV infection that progresses more quickly to cervical cancer compared to women without HIV. Women with HIV are also less likely to participate in routine cervical cancer screening. Higher rates of violence and discrimination, as well as the stigma of an HIV diagnosis, have been reported as barriers to accessing cervical cancer screening within this population. HPV tests detect HPV DNA in the vagina and can be self-collected. The aim of our study was to determine the initial acceptability of and attitudes towards HPV self-sampling among a cohort of women with HIV in Canada. Among a sample of 117 women with HIV aged 18–45, most participants were accepting of HPV self-sampling and agreed that they would use self-sampling in the future; however, some participants were concerned about the implications of receiving a positive HPV result.

Background/Objectives: Our objective was to determine the acceptability of and attitudes towards HPV self-sampling among women with HIV and investigate any associations between self-sampling attitudes and participant demographic and clinical characteristics. Methods: Women with HIV aged 18–45 were given a description of HPV self-sampling and instructions on how to self-collect the sample. Participants completed a questionnaire assessing their perceptions of the acceptability and comfort of HPV self-sampling before using the self-sampling methodology. Responses were based on a 5-point Likert scale (strongly agree to strongly disagree) for each statement. Participants’ characteristics were included in bivariate analysis. Chi-square and Fisher’s exact tests were used to assess associations between questionnaire results and participant characteristics. Results: Of the 117 completed questionnaires, 79.6% of participants had a CD4+ T cell count ≥ 500 cells/mm3. Participants’ median age was 39 (IQR 34–43). One hundred participants (85.5%) felt confident they could collect their samples correctly, and 77.8% did not think they would experience difficulties with self-collection. Most participants (68.4%) preferred to self-collect their sample instead of provider-collected sampling. Ninety-six participants (82.1%) agreed they would likely use self-collection methods for future cervical screening. Many participants were concerned about receiving a positive HPV result (68.4%), passing HPV on to their partner(s) (75.7%), and disclosing their HPV status to friends/family (49.6%). Conclusions: Women with HIV seem to be accepting of HPV self-sampling as a cervical cancer screening methodology; however, many participants were concerned about the implications associated with a positive HPV test result.